Skin Diseases and Their Oral Manifestations: A Comprehensive Overview

This article provides detailed information about skin diseases and their oral manifestations, helping you gain a better understanding of these conditions and appropriate management strategies.

Important Note: This article is for informational purposes only and should not be considered a substitute for professional medical advice. If you experience any unusual symptoms, please consult a doctor for prompt diagnosis and treatment.

1. Incontinentia Pigmenti

• Oral Manifestations:

• Absence of sweat glands.

• Fever and anemia.

• Virtually toothless with no impact on jawbones.

• Causes: A genetic disorder resulting from gene mutations.

• Note: Incontinentia pigmenti is a rare condition that requires diagnosis and management by a medical specialist.

2. White Sponge Nevus (Cannon’s Disease)

• Oral Manifestations:

• Lesions present from birth, often appearing in childhood.

• Can be found in the nose, esophagus, larynx, and anus.

• Distinctive feature: Thickened, keratinized epithelium (hyperkeratosis), broad epithelial papillae.

• White, spongy patches on both cheeks, sometimes on the tongue and alveolar ridge, and floor of the mouth.

• Causes: A genetic disorder caused by gene mutations.

• Note: White sponge nevus is a benign condition and generally does not require treatment.

3. Lichen Planus

• Oral Manifestations:

• Skin: Fine white strands interwoven, “Wickham’s striae” on the flexural surfaces of the elbows and knees, symmetrical on both sides, and on the genitalia.

• Mouth:

• Erosive: Most common, often asymptomatic.

• Annular: Frequently found on the buccal mucosa.

• Causes: The exact cause is unknown, but it may be linked to genetics, immune reactions, medications, stress, etc.

• Note: Lichen planus is a chronic condition and is not cancerous. However, regular monitoring is essential for early detection of complications.

• Treatment:

• Erosive: Topical corticosteroids (1-2 weeks), isotretinoin for atrophic forms, cyclosporine for unresponsive cases.

• Annular: Topical corticosteroids.

4. Psoriasis

• Oral Manifestations:

• Auspitz’s sign: White, yellow-gray plaques on a red, inflamed base, leaving a bloody pinpoint after scraping.

• Mouth: Often non-specific, may include hyperkeratosis, scaling, papules, and ulcers.

• Causes: A combination of genetic predisposition and environmental factors.

• Note: Psoriasis is a chronic condition that requires regular monitoring and treatment as directed by a doctor.

• Treatment:

• Mild: May not require treatment.

• Moderate: Topical corticosteroids, vitamin A and D derivatives, keratolytics.

• Severe: Methotrexate, cyclosporine, phototherapy.

5. Migratory Glossal (Geographic) Tongue

• Oral Manifestations:

• Often found on the tongue.

• Male/Female ratio: 1/2.

• Currently considered a normal physiological phenomenon, no longer classified as a disease.

• Causes: Accumulation of neutrophils that damage the superficial layer of the epithelium, causing redness and atrophy.

• Note: Migratory glossal tongue typically resolves within a few days and does not require specific treatment.

6. Pemphigus (Blistering Diseases)

• Oral Manifestations:

• Nikolsky’s sign: Rubbing or scraping the skin or mucosa causes the epithelium to detach, forming blisters.

• Mouth: Often seen on the palate, mucosa, lips, cheeks, and ventral surface of the tongue.

• Causes: An autoimmune disease caused by autoantibodies against cell adhesion structures.

• Note: Pemphigus is a serious condition that requires prompt diagnosis and treatment by a specialist.

• Treatment: Systemic corticosteroids, immunosuppressants.

• Classification:

• Pemphigus vulgaris: Most common, lesions appear first in the mouth, are fragile, spread rapidly to the face and skin, and can be fatal.

• Pemphigus acutus: Presents with systemic symptoms: high fever, dehydration, albuminuria, and death within 6 weeks.

• Pemphigus vegetans: Hypertrophic, pus-filled papillary growth.

7. Pemphigoid

• Oral Manifestations:

• Mouth: Often affects the conjunctivae, mouth, and can cause blindness.

• Causes: Autoimmune disease caused by antibodies against the basement membrane.

• Note: Pemphigoid is a serious condition requiring timely diagnosis and treatment by a specialist.

• Treatment: Systemic corticosteroids, immunosuppressants.

• Classification:

• Bullous pemphigoid: Common in the elderly.

• Mucous membrane pemphigoid (MMP): Often affects the conjunctivae and mouth.

8. Epidermolysis Bullosa

• Oral Manifestations:

• Genetic disorder, often fatal in early childhood.

• Blisters and erosions, leaving scars and contractures, may show Nikolsky’s sign.

• Causes: Genetic disorder caused by gene mutations.

• Note: Epidermolysis bullosa is a rare condition that requires diagnosis and management by a medical specialist.

9. Dermatitis Herpetiformis

• Oral Manifestations:

• Clusters of vesicles (small, fluid-filled blisters).

• Causes: Gluten sensitivity.

• Note: Dermatitis herpetiformis needs to be diagnosed and treated by a specialist.

• Treatment: Dapsone.

10. Erythema Multiforme

• Oral Manifestations:

• Characteristic target lesions, often on the lower lip, with giant papules.

• Causes: Hypersensitivity reaction to medications, infections, and fungal infections.

• Note: Erythema multiforme is a serious condition that requires prompt diagnosis and treatment by a specialist.

• Treatment: Systemic corticosteroids, immunosuppressants.

• Note: Stevens-Johnson syndrome is a severe form of erythema multiforme.

11. Behçet’s Syndrome

• Oral Manifestations:

• Aphthous ulcers (painful sores).

• Causes: Autoimmune disease, the exact cause is unknown.

• Note: Behçet’s syndrome is a chronic condition that requires diagnosis and treatment by a specialist.

12. Reiter’s Syndrome

• Oral Manifestations:

• Male-predominant, typically affects those in their 30s.

• Mouth: Aphthous ulcers, erythema of the tongue.

• Causes: Autoimmune disease, the exact cause is unknown.

• Note: Reiter’s syndrome requires diagnosis and treatment by a specialist.

13. Lupus Erythematosus

• Oral Manifestations:

• Butterfly-shaped rash across the face (acute SLE).

• Discoid lupus erythematosus (DLE): Common in middle-aged women.

• Causes: Autoimmune disease, possibly linked to genetics or viral infections.

• Note: Lupus erythematosus is a chronic condition that requires diagnosis and treatment by a specialist.

• Treatment: Antimalarials, NSAIDs, dapsone, retinoids.

14. Vitiligo

• Oral Manifestations:

• White patches that do not rub off, and don’t have the clinical features of other conditions.

• Causes: The exact cause is unknown, but it may be linked to genetics, autoimmune mechanisms, stress, fungal infections, etc.

• Note: Vitiligo is a chronic condition and usually not dangerous, but it can affect aesthetics. Regular monitoring is needed to detect complications early.

• Treatment:

• Topical treatments: Corticosteroid creams, vitamin D, immunosuppressants.

• Light therapy.

• Surgery: Skin grafting, laser therapy.

• Classification:

• Segmental vitiligo: White patches are uniform.

• Non-segmental vitiligo: Patches have cracks and ulcers.

15. Xerostomia (Dry Mouth)

• Oral Manifestations:

• Physiological change, common occurrence.

• Causes: Disorders of salivary gland function.

• Note: Xerostomia is generally not dangerous and does not require treatment.

16. Oral Papillomatosis

• Oral Manifestations:

• Often found on the palate and dorsum of the tongue.

• Long-standing lesions, with the potential for sudden malignant transformation.

• Causes: Human papillomavirus (HPV) infection.

• Note: Oral papillomatosis is a precancerous lesion that requires regular monitoring and treatment as directed by a doctor.

17. Actinic Cheilitis

• Oral Manifestations:

• Commonly affects the lips, due to prolonged exposure to sunlight.

• Redness of the lip margin, with hyperkeratosis, blurring of the lip-skin border.

• Causes: Prolonged exposure to sunlight.

• Note: Actinic cheilitis can lead to cancer and needs timely diagnosis and treatment by a specialist.

• Treatment:

• Creams containing PABA.

• Lip stripping surgery.

18. Oral Submucous Fibrosis

• Oral Manifestations:

• Chronic, precancerous lesions that require monitoring.

• Causes: Tobacco use, chewing betel nut, alcohol consumption, etc.

• Note: Oral submucous fibrosis has a high risk of cancer and requires prompt diagnosis and treatment by a specialist.

19. Erythroplakia

• Oral Manifestations:

• Velvety red patches, considered in-situ carcinoma.

• Causes: The exact cause is unknown, but it may be related to genetics, viral infections, immunity, etc.

• Note: Erythroplakia is a precancerous lesion with a high risk of cancer and requires prompt diagnosis and treatment by a specialist.

• Treatment:

• Regular biopsies.

20. Pigmentation Disorders

• Oral Manifestations:

• Hypopigmentation: White patches.

• Hyperpigmentation: Blue patches.

• Causes: Disorders of melanin production.

• Note: Pigmentation disorders are usually not dangerous but can affect aesthetics.

21. Oral Mucosal Pigmentation

• Oral Manifestations:

• Hairy tongue, extensive oral pigmentation, malignant melanoma.

• Causes:

• Genetics.

• Hormonal disorders.

• Metabolic disturbances.

• Medications.

• Infections.

• Radiation exposure.

• Inflammation.

• Note: Oral mucosal pigmentation can be a sign of serious medical conditions and requires prompt diagnosis and treatment by a specialist.

22. Other Skin Diseases

• Herpetic gingivostomatitis: Typically resolves within a few days, no specific treatment required, prone to recurrence.

• Lichenoid drug reaction: Related to medications or chemicals.

• Psoriasis: Associated with excessive sun exposure, not lack of it.

• Hairy leukoplakia: Found in HIV-infected individuals, associated with Epstein-Barr virus.

23. Differential Diagnosis

• Vitiligo: White patches, do not scrape off, often seen on the anterior buccal mucosa.

• Lichen planus: Frequently seen on the posterior buccal mucosa, Wickham’s striae present.

24. General Considerations

• Skin diseases can have diverse presentations, requiring accurate diagnosis by a specialist.

• Avoid self-medicating or home remedies.

• A healthy diet and lifestyle can strengthen your immune system and reduce the risk of skin diseases.

• Schedule regular health checkups to detect any conditions early for timely treatment and improved quality of life.

We hope this article has provided you with valuable information about skin diseases and their oral manifestations. Contact a doctor for personalized advice and treatment.